Home Type 1 Exocrine pancreatic insufficiency and diabetes: What is the relationship?

Exocrine pancreatic insufficiency and diabetes: What is the relationship?

by Amelia Harnish
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Dana Lewis never expected her friend's dog to turn out to be a key clue to solving her mysterious gastrointestinal symptoms, but that's exactly what happened.

Mr. Lewis has suffered from type 1 diabetes for over 20 years. celiac disease And the 16-year-old is used to managing a variety of symptoms alongside her diet. But when she started experiencing gastrointestinal discomfort after her meals a few years ago, all her usual strategies seemed to make no difference.

“As a diabetic, I'm used to adjusting my diet based on my mood,” Lewis says. “I'm careful to avoid gluten, so I knew it wasn't gluten. But I still felt sick after eating it.”

She saw a gastroenterologist in January 2020 and was tested for numerous infections and parasites, all of which came back negative.She experimented with an elimination diet, but she still had no idea.. It wasn't until a friend posted on Facebook about a solution to her dog's digestive problems that Lewis found the answer: exocrine pancreatic insufficiency (EPI).

“When we sprinkled enzyme powder on the dog's food, his symptoms completely disappeared,” Lewis said. “I was curious to see if this same problem happens to humans, so I looked it up and found out that it does happen. I immediately made another appointment with my doctor and said, 'Let's get tested for this. 'Sho,' he said.

After testing positive and being diagnosed with EPI, Lewis was surprised to learn that diabetics are at higher risk. However, it often goes unnoticed by doctors. Here's what you need to know about EPI and diabetes.

What exactly is EPI?

Exocrine pancreatic insufficiency occurs when the pancreas is unable to produce adequate amounts of digestive enzymes needed for proper digestion and absorption of nutrients from food. Another name for EPI is exocrine pancreatic insufficiency.

Your body requires digestive enzymes, such as amylase and lipase, produced by the pancreas, to break down and absorb proteins, fats, and proteins. carbohydrates. Without adequate amounts of enzymes made by the pancreas, the body can have difficulty digesting food. This can lead to malnutrition as well as gastrointestinal symptoms such as:

  • abdominal pain
  • increase in gas
  • Changes in stool, especially steatorrhea or diarrhea
  • Weight loss

What causes EPI?

“Damage to the pancreas is the main cause of EPI,” says Dr Philip Johnston, consultant in endocrinology, diabetes and medicine at the Northern Ireland Regional Center for Endocrinology and Diabetes, Royal Victoria Hospital and Belfast City Hospital.

Chronic pancreatitis, in which the pancreas remains inflamed for a long period of time, is the most dangerous. Researched the cause of EPI. But many things can damage the pancreas, Johnston said, including tissue destruction or removal from surgery, nerve damage, blocked ducts, and autoimmune reactions.

Researchers don't know exactly why, but studies have shown a link between EPI and diabetes.

“Postmortem examination of the pancreas of diabetic patients shows signs of structural changes and damage, including fibrosis, shrinkage, fatty infiltration, evidence of chronic inflammation, and reduced size,” Dr. Johnston said.

“Genetic abnormalities, infections, or autoimmune conditions can damage pancreatic tissue, resulting in insulin deficiency and decreased digestive enzymes, resulting in the presence of both diabetes and EPI. ' he explained.

of Reported prevalence The proportion of patients with diabetes and EPI varies widely (25–74%), but it appears to be more common in patients with type 1 diabetes compared to type 2 diabetes. The rate of EPI is estimated to be much higher in diabetic patients due to pancreatic disease. or pancreatic diabetes.

“In my own practice, EPI is very common not only in pancreatic diabetes, but also in type 1 patients with long-term diabetes and patients with poor glycemic control,” Dr. Johnston added.

Why is EPI underdiagnosed in patients with diabetes?

Given the high prevalence of diabetes, it's surprising that so many people have never heard of it and so few doctors test for it.

Lewis happens to be a diabetes researcher; Published a paper on EPII had to work really hard to get tested and start treatment.

“I had never heard anyone in the diabetes world talk about EPI. That shocked me,” Lewis said.

Lewis and Johnston agreed that there are multiple factors to this problem. First, the symptoms of EPI can range from mild to severe and can be overlooked as just part of, or associated with, a specific type of diabetes. diabetes medicine Known to cause gastrointestinal discomfort.

Lewis experienced symptoms for years before they became severe enough to see a gastroenterologist. The comfort I felt in researching the medical literature allowed me to find answers and advocate for myself.

Another reason why EPI is often overlooked is the lack of awareness of this condition among diabetes clinicians. Part of the reason is that there aren't enough screening tests.

“All we can do is one stool test. If you have diarrhea (a symptom of EPI), that could affect the sample,” Lewis said. “So this test is not always reliable.”

“Although any form of diabetes can increase the risk of EPI, the diagnosis of EPI in this population remains underrecognized, and targeted screening tools for EPI that are not part of usual diabetes care are needed.” continues to be ignored,” Johnston said.

To improve the recognition and proper diagnosis of EPI, Dr. Johnston said healthcare providers need to think more about the pancreas as a whole, which has two main functions: insulin production and digestive enzymes.

What is the treatment for EPI?

The good news is that there are treatments for EPI. pancreatic enzyme. This oral treatment essentially replaces the missing enzymes. However, administering pancreatic enzymes can be difficult.

“There is limited data on what dosage is optimal,” Johnston says. “I know there are apps and calculators in development to help with dose titration.”

He added that EPI patients taking enzymes who still have gastrointestinal symptoms should talk to their medical team about the possibility of increasing their dose.

Lewis has been using pancreatic enzymes for several years. It took some trial and error for him, but his symptoms resolved.

“As a diabetic, I'm used to adjusting doses based on diet,” Lewis said. “Treatment is not easy, but knowing it can change your life.”

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